
    <div id="content" class="col-sm-9"> 
      <form action="" method="post" enctype="multipart/form-data" class="form-horizontal">
        <fieldset>
          <legend>Your Personal Details</legend>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-firstname">Nama </label>
            <div class="col-sm-10">
              <input type="text" name="firstname" value="" placeholder="Nama" id="input-firstname" class="form-control">
                          </div>
          </div>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-lastname">Username</label>
            <div class="col-sm-10">
              <input type="text" name="lastname" value="" placeholder="Username" id="input-lastname" class="form-control">
                          </div>
          </div>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-email">Password</label>
            <div class="col-sm-10">
              <input type="email" name="email" value="" placeholder="Password" id="input-email" class="form-control">
                          </div>
          </div>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-telephone">Alamat</label>
            <div class="col-sm-10">
              <input type="tel" name="telephone" value="" placeholder="Alamat" id="input-telephone" class="form-control">
                          </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-fax">Kode Pos</label>
            <div class="col-sm-10">
              <input type="text" name="fax" value="" placeholder="Kode Pos" id="input-fax" class="form-control">
            </div>
          </div>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-password">Tanggal Lahir</label>
            <div class="col-sm-10">
              <input type="text" name="password" value="" placeholder="Tanggal Lahir" id="input-password" class="form-control">
            </div>
          </div>
        <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-confirm">Email</label>
            <div class="col-sm-10">
              <input type="email" name="confirm" value="" placeholder="Email" id="input-confirm" class="form-control">
            </div>
          </div>
        <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-confirm">No HP</label>
            <div class="col-sm-10">
              <input type="text" name="confirm" value="" placeholder="No HP" id="input-confirm" class="form-control">
            </div>
          </div>
         </fieldset>
        <div class="buttons clearfix">
          <div class="pull-left">
            <input type=button value=Back class="btn btn-default" onclick=self.history.back()>
          </div>
          <div class="pull-right">
            <input type="submit" value="Continue" class="btn btn-primary">
          </div>
        </div>
      </form>
      </div>